Selective Serotonin Reuptake Inhibitors (SSRIs)

Summary: Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of medications commonly used to treat conditions such as depression and anxiety (including generalized anxiety and obsessive compulsive disorder).

Overview

Selective Serotonin Reuptake Inhibitors (SSRIs) belong to a group of medications called antidepressants. There are six SSRIs available in Canada. These include:

Citalopram (Celexa®)

Escitalopram (Cipralex®)

Fluoxetine (Prozac®)

Fluvoxamine (Luvox®)

Paroxetine (Paxil®)

Sertraline (Zoloft®)

What are SSRIs used for?

Though these medications are called “antidepressants” they may be used for conditions other than depression. When the potential benefits (e.g., reducing your symptoms) of using an SSRI outweigh the potential risks (e.g., the side effects), many doctors prescribe one of these medications for:

Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor.

How do SSRIs work?

SSRIs are known to increase the amount of a brain chemical called serotonin. It is believed that some brain chemicals, such as serotonin and norepinephrine, are not working well in people who are depressed or overly anxious. The exact way that SSRIs improve the symptoms of depression and anxiety disorders is still not fully known.

SSRIs in children and adolescents

Certain SSRIs, such as fluoxetine, sertraline and fluvoxamine have been officially approved by the FDA for use in children and adolescents in the United States.

Several SSRIs have been studied in children and adolescents diagnosed with an anxiety disorder or depression. When used to treat an anxiety disorder, there is good evidence that SSRIs are more effective than a placebo (an inactive pill that looks like medication) at decreasing symptoms of anxiety. In the treatment of OCD in particular, there is good evidence that OCD symptoms are reduced to a greater degree by an SSRI compared to a placebo. Research supports the use of certain SSRIs in children and adolescents with depression. However, some studies in childhood depression have found that certain SSRIs are not better at treating depression symptoms compared to a placebo. Whenever possible, the addition of behavioural therapy (such as Interpersonal Therapy (IPT) for depression or Cognitive Behaviour Therapy (CBT) to this medication may help to increase the potential for benefit.

In general, for depressed youth who take an SSRI for 2-3 months, about 5-6 people out of every 10 who are treated will notice an improvement in their depressive symptoms (such as depressed mood, disturbed sleep, changes in appetite, lack of energy, poor concentration and fatigue). However, in depressed youth who are given a placebo for 2-3 months, about 4-5 people out of every 10 who are treated also have a reduction in depressive symptoms.

How should an SSRI be taken?

SSRIs are usually taken once a day. SSRIs are available in several forms such as capsules, tablets and liquid (fluoxetine). You can take this medication with or without food; however there may be less stomach upset if you take it with food or milk. This medication should be taken at the same time each day as directed by your doctor. Try to connect it with something you do everyday (like eating breakfast or brushing your teeth) so that you don’t forget.

SSRIs can be taken with meals (may help decrease stomach upset), milk, water, orange or apple juice. AVOID taking SSRIs with grapefruit, because grapefruit may interact with some SSRI medications.

Usually, your doctor will start with a low dose. This dose will be slowly increased based on how you respond to it. You and your doctor can then discuss the best dosage to stay on based on how you tolerate this medication (how well the medication is working and how you are doing with the side effects of the medication) and how well it helps to decrease your symptoms.

When will the SSRI start working?

This medication needs to be taken for 3 to 6 weeks before you begin to feel better. Different symptoms may start to improve at different times. For example, improvements in sleep, appetite and energy may be seen within the first 2 weeks. Sometimes, others will notice improvements in you before you do. Full beneficial effects may take 4 to 8 weeks (or longer). Since this medication takes time to work, do not increase, decrease or stop them without discussing it with your doctor first.

If you are not feeling better within 6 to 8 weeks, your doctor may recommend you take a different medication. There is a small chance that your symptoms may worsen or that you may experience increased thoughts of self harm during the first couple of months of taking this medication (see section on side effects). If this happens, tell your doctor IMMEDIATELY.

How long do I have to take an SSRI?

This depends on the symptoms you have, how frequent they occur and how long you have had them. Most people need to take this medication for at least 6 months. This allows time for your symptoms to stabilize and for you to regain your functioning. After this time, you and your doctor should discuss the benefits and risks of continuing treatment.

If you have had several episodes of severe depressive or anxiety symptoms and you tolerate this medication well, you may be asked to take this medication for an indefinite amount of time. By continuing to take this medication, you significantly decrease the chance that you may have another episode of depression or anxiety.

Do NOT stop taking this medication (even if you are feeling better) without discussing it with your doctor first. If you stop taking this medication suddenly, it is possible that your symptoms may return or you may have a bad reaction.

Once you have started taking this medication, you and your doctor will need to monitor for both the beneficial and unwanted effects. Your doctor will check your progress and discuss changes in symptoms during the next 3 months to confirm that this medication is working properly and that possible side effects are avoided. At this time, you can discuss how long you might need to take this medication.

Are SSRIs addictive?

No, SSRIs are not addictive. You will not have “cravings” for this medication like some people do with nicotine or street drugs. If you and your doctor decide it is best for you to stop taking an SSRI, your doctor will explain how to safely lower the dose so you won’t feel any unpleasant “flu-like” effects (chills, nausea, vomiting, dizziness, tingling in hands and feet, muscle aches, fever and electrical sensations) as your body adjusts to being without this medication.

What are the side effects of an SSRI and what should I do if I get them?

As with most medications, side effects may occur when taking an SSRI. Most side effects are mild and temporary. Side effects may occur before any of the beneficial effects. It is possible for some individuals to experience side effects that they feel are serious or long lasting. If you feel this has happened, speak with your doctor right away.

Below are some of the common side effects and potentially serious side effects of taking this medication, and in brackets are suggested ways to lessen these effects.

Common side effects

Side effects may be more common when starting a medication or after a dose increase. If any of these side effects is too troublesome for you, please discuss them with your doctor, nurse or pharmacist.

Decreased appetite (try eating smaller, more frequent meals)

Diarrhea (usually disappears in the first week)

Difficulty sleeping (try taking the medication earlier in the day)

Drowsiness/fatigue (take the dose at bedtime; this usually lessens over time)

Contact your doctor IMMEDIATELY if you have any of these uncommon, potentially serious side effects:

Change in mood to an unusual state of excitement, irritability or happiness

Seizure (also called fits or convulsions)

Skin rash, itchy skin or hives

Uncomfortable sense of inner restlessness or agitation

Unusual bruising or bleeding

Unusual sensations or experiences (e.g. hallucinations)

Thoughts of self harm, hostility or suicide

What precautions should my doctor and I be aware of when taking an SSRI?

Tell your doctor or pharmacist if you:

begin taking any other new medication (prescription or non-prescription), since several other medications can interact with SSRIs

feel drowsy, dizzy or slowed down. SSRIs can make some individuals experience these temporary side effects, so if you feel this way, it is important to avoid operating heavy machinery or driving a car. SSRIs may increase the effects of alcohol, resulting in more sedation or dizziness

have a history of diabetes, heart disease, thyroid disease, kidney or liver disease or seizures

have any allergies or have experienced a reaction to a medication

have any changes in mood or thoughts of self harm

if you develop any new medical problem while you are taking an SSRI

miss a period, become pregnant or are trying to become pregnant or are breast-feeding

What special instructions should I follow while taking an SSRI?

Keep all appointments with your doctor and the laboratory.

Do not allow anyone else to use your medication.

It is a good idea to have a visit or telephone call with your doctor within 1-2 weeks after you start taking an SSRI, and then periodically after that to see how well the medication is working, how well you are tolerating the medication, and to discuss any problems you may have.

What should I do if I forget to take a dose?

If you take this medication once daily at bedtime and you forget to take it, skip the missed dose and continue with your schedule the next day. Do NOT double your next dose. If you take it more than once a day, take the missed dose as soon as possible. However, if it is almost time for your next dose (e.g., within 4 hours), do not take the missed dose or double your next dose. Instead, continue your regular dosing schedule.

What storage conditions are needed for SSRIs?

Keep this medication in the original container, stored at room temperature away from moisture and heat (e.g., not in the bathroom or kitchen).

Keep this medication out of reach and sight of children.

About this Document

Special thanks to the Kelty Centre for Mental Health for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, and reviewed by the staff of the Kelty Mental Health Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health and the Children's Hospital of Eastern Ontario, Canada.

Creative Commons License

You are free to copy and distribute this material unchanged and in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/. For any other uses, please contact the original rights holder, the Kelty Mental Health Centre.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

Patient Handouts

Do I Have an Anxiety Disorder?
Do you find that that many of the following apply to you...
I am often startled by the smallest thing
I worry that something terrible will happen to me or others
I am easily irritable
I get sudden fears of dying or doing something out of control
I often worry that something has not been done correctly even though I know I completed the task properly
I am extremely worried about disease (e.g. germs, infections, dirt, dust, contaminates, cleanliness)
I need constant reassurance
I often find myself doing things repeatedly (e.g. hand washing, showering, tooth ...

Introduction
Dylan is afraid of the dark. Tricia hates to eat in front of other people. Eric becomes sick to his stomach and throws up if he has to speak aloud in class. Fears and worries are a very normal part of life for children and adults. However, if these worries become cause for concern because they are affecting day-to-day functioning significantly, we refer to these excessive worries as anxiety.
How Common are Anxiety Disorders?
Anxiety disorders are the most common mental health condition in children and adults. Roughly 6% of children and youth have an anxiety disorder that is serious enough to require treatment.
How Long ...

What is Depression?
Everyone has times when they feel the ‘blues' or when they get sad from time to time. Depression on the other hand, is a sadness so severe that it can cause:
Difficulties functioning at home, work or school
Changes in sleep, energy, appetite and concentration,
Feelings such as sadness, anxiety, irritability or anger,
Low self-esteem or feelings of hopelessness. When extremely severe, people who are depressed may have thoughts of hurting themselves.
How Common is Depression?
Depression is a common condition that can affect anyone at any age. In any given year, it is estimated that ...

Case, Part 1
T. is a 15-year old female brought who lives with both parents, and is seeing you just a few months after having started high school
She is brought by her mother to the appointment, ostensibly due to new onset headaches and stomaches
Her physical symptoms have been severe enough, that she has missed severe days of school
You ask about her mood, and she breaks down crying, saying that she has felt sad for the past few months
Symptoms include problems with sleep, appetite, energy and concentration since the school year started
You meet alone with her, and when you ask ...

What is depression?
It is normal for children and youth to feel sad from time to time. But this sadness doesn’t stop them from going on with their everyday activities. And it goes away on its own. Depression, on the other hand, is a sadness so severe that it interferes with everyday life.
Typical symptoms of depression (aka clinical depression, or major depressive disorder) are:
Feeling sad, worried, irritable or angry
Lack of enjoyment in life, or troubles enjoying anything
Feeling hopeless and worthlessHaving troubles coping with everyday activities at home, school, or ...

Antidepressants, anti-anxiety medications, and beta-blockers are the most common medications used for anxiety disorders.

Anxiety disorders include:

Obsessive compulsive disorder (OCD)

Post-traumatic stress disorder (PTSD)

Generalized anxiety disorder (GAD)

Panic disorder

Social phobia.

Antidepressants

Antidepressants were developed to treat depression, but they also help people with anxiety disorders. SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. The SNRI venlafaxine (Effexor) is commonly used to treat GAD. The antidepressant bupropion (Wellbutrin) is also sometimes used. When treating anxiety disorders, antidepressants generally are started at low doses and increased over time.

Some tricyclic antidepressants work well for anxiety. For example, imipramine (Tofranil) is prescribed for panic disorder and GAD. Clomipramine (Anafranil) is used to treat OCD. Tricyclics are also started at low doses and increased over time.

MAOIs are also used for anxiety disorders. Doctors sometimes prescribe phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). People who take MAOIs must avoid certain food and medicines that can interact with their medicine and cause dangerous increases in blood pressure. For more information, see the section on medications used to treat depression.

Benzodiazepines (anti-anxiety medications)

The anti-anxiety medications called benzodiazepines can start working more quickly than antidepressants. The ones used to treat anxiety disorders include:

Clonazepam (Klonopin), which is used for social phobia and GAD

Lorazepam (Ativan), which is used for panic disorder

Alprazolam (Xanax), which is used for panic disorder and GAD.

Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.

Clonazepam, listed above, is an anticonvulsant medication. See FDA warning on anticonvulsants under the bipolar disorder section.

Beta-blockers

Beta-blockers control some of the physical symptoms of anxiety, such as trembling and sweating. Propranolol (Inderal) is a beta-blocker usually used to treat heart conditions and high blood pressure. The medicine also helps people who have physical problems related to anxiety. For example, when a person with social phobia must face a stressful situation, such as giving a speech, or attending an important meeting, a doctor may prescribe a beta-blocker. Taking the medicine for a short period of time can help the person keep physical symptoms under control.

What are the side effects?

See the section on antidepressants for a discussion on side effects. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:

Upset stomach

Blurred vision

Headache

Confusion

Grogginess

Nightmares.

Possible side effects from buspirone (BuSpar) include:

Dizziness

Headaches

Nausea

Nervousness

Lightheadedness

Excitement

Trouble sleeping.

Common side effects from beta-blockers include:

Fatigue

Cold hands

Dizziness

Weakness.

In addition, beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms.

How should medications for anxiety disorders be taken?

People can build a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may become dependent on them. To avoid these problems, doctors usually prescribe the medication for short periods, a practice that is especially helpful for people who have substance abuse problems or who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may get withdrawal symptoms, or their anxiety may return. Therefore, they should be tapered off slowly.

Buspirone and beta-blockers are similar. They are usually taken on a short-term basis for anxiety. Both should be tapered off slowly. Talk to the doctor before stopping any anti-anxiety medication.

Reprints:

This publication is in the public domain and may be reproduced or copied without permission from NIMH. We encourage you to reproduce it and use it in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of providing such information.

NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and "brand" when using the publication.

Addition of non-Federal Government logos and Web site links may not have the appearance of NIMH endorsement of any specific commercial products or services or medical treatments or services.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or e-mail at [email protected]

The photos in this publication are of models and are used for illustrative purposes only.

What medications are used to treat depression?
Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine.
&nb...

Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine.

The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:

Fluoxetine (Prozac)

Citalopram (Celexa)

Sertraline (Zoloft)

Paroxetine (Paxil)

Escitalopram (Lexapro).

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.

SSRIs and SNRIs are popular because they do not cause as many side effects as older classes of antidepressants. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

What are the side effects?

Antidepressants may cause mild side effects that usually do not last long. Any unusual reactions or side effects should be reported to a doctor immediately.

The most common side effects associated with SSRIs and SNRIs include:

Headache, which usually goes away within a few days.

Nausea (feeling sick to your stomach), which usually goes away within a few days.

Sleeplessness or drowsiness, which may happen during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.

Agitation (feeling jittery).

Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex.

Tricyclic antidepressants can cause side effects, including:

Dry mouth.

Constipation.

Bladder problems. It may be hard to empty the bladder, or the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected.

Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex.

Blurred vision, which usually goes away quickly.

Drowsiness. Usually, antidepressants that make you drowsy are taken at bedtime.

People taking MAOIs need to be careful about the foods they eat and the medicines they take. Foods and medicines that contain high levels of a chemical called tyramine are dangerous for people taking MAOIs. Tyramine is found in some cheeses, wines, and pickles. The chemical is also in some medications, including decongestants and over-the-counter cold medicine.

Mixing MAOIs and tyramine can cause a sharp increase in blood pressure, which can lead to stroke. People taking MAOIs should ask their doctors for a complete list of foods, medicines, and other substances to avoid. An MAOI skin patch has recently been developed and may help reduce some of these risks. A doctor can help a person figure out if a patch or a pill will work for him or her.

How should antidepressants be taken?

People taking antidepressants need to follow their doctors' directions. The medication should be taken in the right dose for the right amount of time. It can take three or four weeks until the medicine takes effect. Some people take the medications for a short time, and some people take them for much longer periods. People with long-term or severe depression may need to take medication for a long time.

Once a person is taking antidepressants, it is important not to stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It's important to give the body time to adjust to the change. People don't get addicted, or "hooked," on the medications, but stopping them abruptly can cause withdrawal symptoms.

If a medication does not work, it is helpful to be open to trying another one. A study funded by NIMH found that if a person with difficult-to-treat depression did not get better with a first medication, chances of getting better increased when the person tried a new one or added a second medication to his or her treatment. The study was called STAR*D (Sequenced Treatment Alternatives to Relieve Depression).2,3

Are herbal medicines used to treat depression?

The herbal medicine St. John's wort has been used for centuries in many folk and herbal remedies. Today in Europe, it is used widely to treat mild-to-moderate depression. In the United States, it is one of the top-selling botanical products.

The National Institutes of Health conducted a clinical trial to determine the effectiveness of treating adults who have major depression with St. Johns wort. The study included 340 people diagnosed with major depression. One-third of the people took the herbal medicine, one-third took an SSRI, and one-third took a placebo, or "sugar pill." The people did not know what they were taking. The study found that St. John's wort was no more effective than the placebo in treating major depression.4 A study currently in progress is looking at the effectiveness of St. John's wort for treating mild or minor depression.

Other research has shown that St. John's wort can dangerously interact with other medications, including those used to control HIV. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. Also, St. Johns wort may interfere with oral contraceptives.

Because St. John's wort may not mix well with other medications, people should always talk with their doctors before taking it or any herbal supplement.

FDA warning on antidepressants

Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects, especially in young people. In 2004, the FDA looked at published and unpublished data on trials of antidepressants that involved nearly 4,400 children and adolescents. They found that 4 percent of those taking antidepressants thought about or tried suicide (although no suicides occurred), compared to 2 percent of those receiving placebos (sugar pill).

In 2005, the FDA decided to adopt a "black box" warning label—the most serious type of warning—on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24.

The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. To find the latest information visit the FDA website.

Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.5 The study was funded in part by NIMH.

Finally, the FDA has warned that combining the newer SSRI or SNRI antidepressants with one of the commonly-used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome." A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.

Reprints:

This publication is in the public domain and may be reproduced or copied without permission from NIMH. We encourage you to reproduce it and use it in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of providing such information.

NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and "brand" when using the publication.

Addition of non-Federal Government logos and Web site links may not have the appearance of NIMH endorsement of any specific commercial products or services or medical treatments or services.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or e-mail at [email protected]

The photos in this publication are of models and are used for illustrative purposes only.

School Letter

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About this letter: This is a sample “School Letter” that a health professional can write to a patient’s educators to support a student with anxiety. Feel free to cut/paste in your work.
Authors: This sample letter was written by Dr’s Olivia Macleod and the mental health professionals at the Children’s Hospital of Eastern Ontario (CHEO), in coll...

About this letter: This is a sample “School Letter” that a health professional can write to a patient’s educators to support a student with anxiety. Feel free to cut/paste in your work.

Authors: This sample letter was written by Dr’s Olivia Macleod and the mental health professionals at the Children’s Hospital of Eastern Ontario (CHEO), in collaboration with Donaleen Hawes and Michelle Neville, Catholic District School Board of Eastern Ontario (CDSBEO).

License: Under a Creative Commons License. You are free to share, copy and adapt this work in the work of helping your

students. Note however, that otherwise, this work may not be used for commercial purposes.

Dear Educator:

I am writing to give you an update regarding your student, who is coping with an Anxiety Condition.

I am writing to give you an update regarding your student, who is known to me for an anxiety condition. Anxiety is characterized by feeling that 1) the world and environment are unsafe, and/or 2) feeling unable to cope with the environment and manage uncertainty.

Accommodations are essential for this student to function in the academic program. Here is a list of general recommendations.

Ensure this student feels connected to the adults. Perhaps the single most important intervention that can help a student feel better able to cope with anxiety and safer is to help the student feel connected to caring adults at the school. This includes:

Finding time to connect at the beginning of the day

Accepting and validating the student’s anxiety, e.g. “I wonder if you’re feeling anxious… I appreciate it can’t be easy.”

Have breaks as needed in a designated “chill out space”. Use regular breaks as a preventive measure for stress buildup. Ensure that there are also opportunities for the student to let you know when things are stressful, and then the student can have a break as needed (i.e., break card). The “chill out space” is a space in a calmer (i.e. less sensory input), relatively private place at school where the student can use different coping strategies until the student is feeling calmer. Examples vary depending on the student and the school, but may include a corner in the classroom; or a resource room where there are less students; or the library.

Problem-solve and debrief anxiety incidents. After the student has calmed down, try to find a time to help problem-solve around triggers that led to the anxiety.

Set clear expectations and try to check if the student understands. Some students have anxiety because they want to please the teacher, yet they are uncertain about their teacher’s expectations, but are too anxious to let the teacher know that they don’t understand.

Chunk work. Be prepared to “chunk” larger work into smaller manageable pieces and provide ongoing feedback, or offers to help.

Expose the student to challenges step by step. For example, with performance anxiety, the student can initially present material only to the teacher or in small groups. If the student is successful with this, they can move towards presenting to larger and larger numbers of students, until it is the full class.

Don’t put him/her on the spot by calling on them to answer a question in front of the class. Even though the student may be perfectly capable of answering a question, the student may still be anxious with being the centre of attention.

Allow the student to choose a partner during group work and, when possible, allow him/her to work only with one partner (as opposed to a larger group).

Provide sensory materials (i.e., fidgets) to decrease feelings of stress thereby allowing the student to concentrate on the task at hand.

For tests and exams, consider a separate testing room and extra time if needed.

For older students, a reduced course load may be needed. The possibility of a resource period, or learning skills course, should be explored.

Strategies for Classroom Education and Destigmatizing Anxiety

Consider having a classroom lesson about anxiety, and ways of coping, which helps all students be more understanding with anxiety. Do not single out students with anxiety by mentioning their names, but rather make the lesson about anxiety in general.

Model self-compassion. For many students, anxiety is about feeling unsafe due to not measuring up to expectations around them. Teach self-compassion by ensuring that the classroom models the following:

Mindfulness: Teach students how to be in the moment, rather than distracted.

Kindness and compassion to others: Have a classroom that values kindness over competition.

Kindness and compassion to ourselves: When you hear students being self-critical, reframe the criticism in a positive and forgiving manner.

Gratitude: Consider incorporating gratitude into school routines, such as at the end of the classroom day.

Stop stigma and teasing. Deal immediately with any negative behavior by peers towards more sensitive students.

For more information about supporting students with anxiety in the school:

Building Resilient Students with Positive Mental Health
http://smh-assist.ca/blog/2016/03/15/building-resilient-students-with-positive-mental-health-flip-book-cdsbeo/

Thank you for the work you do every day in supporting this student. Please do not hesitate to contact me if you have any questions or comments.

NAME OF HEALTH PROFESSIONAL, TITLE

CONTACT INFORMATION

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I am writing to give you an update regarding your student, who having Mood Problems, i.e. Depression.
Accommodations are essential for this student to function in the academic program. Feel free to adapt this list, however, here is a general list of suggested accommodations.
Instructional Strategies
Interpersonal interventions
Fe...

I am writing to give you an update regarding your student, who having Mood Problems, i.e. Depression.

Accommodations are essential for this student to function in the academic program. Feel free to adapt this list, however, here is a general list of suggested accommodations.

Instructional Strategies

Interpersonal interventions

Feeling connected to people is particularly important with mood problems, particularly because students with mood problems youth tend to withdraw from others. Help connect the student to supportive peers, and offer opportunities to participate in organized school activities such as clubs, sports.

Make a special contact with the student each day. Maybe a specific greeting at the door followed by a question about something that has been of interest to the student.

Build strength and resiliency by reinforcing successes and positives

What times has your student been successful at things in the past? What are your student’s strengths? Tell the student about any positives.

Being successful and accomplishing tasks increases self-esteem so find ways to ensure the student has chances to achieve, even at his/her lower energy level and reduced ability to concentrate.

Reduce workload

Mood problems such as depression may lower the student’s ability to work. Consider temporarily reducing the academic expectations and workload. Just like one might modify job tasks for a worker with back injury, it is important to modify tasks for a student with mood problems.

Give more time

Students with mood problems tend to have problems with attention and concentration. Give more time, break assignments into smaller pieces, offer extra help in setting up schedules or study habits, or pair the student with others who express an interest in helping.

Coping / Stress Breaks (aka ‘Chill Time’) (Try to avoid the term ‘Time Out’ because for some students this has a negative connotation…)

Expressing stress -- Come up with a system to help the student identify when s/he is getting overwhelmed, and be able to communicate that to the teachers.

For example, using a 5-point scale, where 1 is no problems, and 5 is being stressed and overwhelmed

Create a safe space

Designate a “chill out zone” / “safe place” where the student can go if s/he is feeling overwhelmed. By giving the student the ability to calm down at school, this will lessen the chances that the student will end up leaving the school.

Talk ahead of time privately with the student, and set up some signal or cue so that the student can leave the class if the student is getting overwhelmed.

Set clear expectations

Many students have anxiety because they are uncertain about their teacher’s expectations. To help with this, provide the student with explicit guidelines for assignments. In addition, explicit guidelines for assignments help mitigate the negative impact of anxiety and depression symptoms on executive functioning. (Executive skills help a student to regulate his or her behavior. Through the use of these skills a student can plan and organize activities, sustain attention, and persist to complete a task.)

Classroom Education / Anti-Stigma

Consider having a lesson about mood problems, in order for other students to know about anxiety so that they can understand what the student with mood problems is going through. Do not single out the student with mood problems, but make the lesson a about mood problems in general. For more information, the CMHA has an excellent curriculum here www.cmha.ca/highschoolcurriculum/

Provide copies of classroom notes to cover absences due to anxiety, as the student may be missing classes due to anxiety, or doctor’s appointments.

Coping Plan

Involve the student in coming up with a coping plan, whose elements might include:

Student’s strengths

Potential problems or issues

Strategies and solutions to try

Suicidal ideation and crises

Although depression does get better in the vast majority of situations, youth with mood problems may become overwhelmed to the point where they may feel passively suicidal (“Life isn’t worth living”), or actively suicidal (“Life isn’t worth living, and I’m going to do something to end my life.”)

Learn about local resources (i.e. where you might get professional help) in case there are concerns about suicidality. Most likely, your school board already has a policy and procedure in place for such urgent situations.

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There are many ways that schools can help a child with panic disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifi...

There are many ways that schools can help a child with panic disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following:

Establish check-ins on arrival to see if the child can succeed in certain classes that day

Allow the student to “cue” teachers or staff if a panic attack is occurring so that the student can go to a less stressful (or embarrassing) environment. At the same time, reward the student for efforts to remain in class and control the panic attacks.

Provide more time to complete certain types of assignments

Accommodate late arrival due to symptoms at home

Adjust the homework load to prevent the child from becoming overwhelmed. Academic stressors, along with other stresses, may aggravate symptoms.

Develop relaxation techniques to help reduce anxiety at school. Employing techniques developed at home can also be useful.

Identify a safe place where the child may go to reduce anxiety during stressful periods. Developing guidelines for its appropriate use will help both the student and staff.

Encourage the child to develop helpful interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child's ability to problem-solve.

Anticipate issues such as school avoidance if there are unresolved social and/or academic problems

Provide assistance with peer interactions. An adult's help may be very beneficial for both the child and his or her peers.

Be aware that transitions may be difficult for the child. When a child with panic disorder refuses to follow directions, for example, the reason may be symptoms of anxiety rather than intentional oppositionality.

Flexibility and a supportive environment are essential for a student with panic disorder to achieve success in school. School faculty and parents together may be able to identify patterns of difficulty and develop remedies to reduce a child's challenges at these times.

Workplace Accommodation

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Examples of Common Workplace Accommodations
Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:
Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be f...

Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:

Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be from within the organization.

Flexible scheduling to accommodate effects of medications, time for appointments, more frequent breaks, switch to temporary part-time hours without fear of losing job.

Changes in supervision, for example how feedback and instruction are given, or having weekly supervision appointments to check in and prevent problems before they can happen.

In training, allowing more time for tasks to be learned, or allowing for individualized, one-on-one training.

Appropriate technology like a tape recorder to tape instructions, head phones to block out loud noise, etc.

Modifying work space or changing location so it is quieter, fewer distractions; allowing an employee to work at home.

Allowing an employee to exchange minor job tasks with others.

Rights and Responsibilities of the Employer & Employee

The Employer Should:

Create and maintain an atmosphere where people feel comfortable asking for accommodation, including providing information about the organization’s policies and creating ways for requests to happen confidentially.

Assume that the employee’s request for accommodation is made in good faith.

In a timely manner, work with the employee (and a professional, if necessary), to explore all options for accommodation.

Maintain records of the request and steps taken to deal with the request.

Maintain and respect confidentiality issues.

Pay the cost of the accommodations, including fees for any medical certificates required.

Request only information that is directly related to developing an appropriate accommodation.

Ensure that managers and supervisory staff will not tolerate any discrimination or harassment as a result of an illness or an accommodation.

The Employee Should

Tell the employer you need an accommodation, due to a disability, and give them the information they need to understand what the limitations are and what accommodations would address them.

External Links

A self-care manual to help employees and businesses cope with depression and mood problems at work. People can use it to identify whether they are experiencing depression or depressed mood, and apply practical strategies to reduce effects on work satisfaction and performance.

Documentary about depression, available free on streaming video. "Statistics reveal that depression in children and youth is on the rise. In fact, it has increased by one-third in the past 30 years. Untreated depression costs a teenager in many ways: lost educational opportunities, lost social opportunities and lost time. Through the personal stories of three young people, this compelling documentary traces the journey of depression, from early signs and symptoms, to assessment, diagnosis and treatment. The documentary also helps shatter some stereotypes.
2004, 56 min 30 s
Directed by
Maureen Palmer
Produced by
Sharon Bartlett
Maria LeRose"

The Centre of Knowledge on Healthy Child Development gives you access to important and up-to-date information that is based on the best scientific research currently available. It's designed to help you sort through all the conflicting information about what promotes, and what hinders, healthy child development so you can make better choices that will result in better outcomes for children.

A suicide prevention comic book created by the Healthy Aboriginal Network, a BC-incorporated non-profit society. It's the story of a teenager who is bullied at school, misunderstood by his teacher and feels socially isolated from his family. He finds one day very overwhelming and considers taking his own life. Youth find Darkness Calls non-threatening and relatable, so it's a terrific ice breaker to get them talking about how they feel.
Cost is contingent on amount ordered, please visit the website for more information.

Depression Quest is an interactive fiction game where you play as someone living with depression. You are given a series of everyday life events and have to attempt to manage your illness, relationships, job, and possible treatment. This game aims to show other sufferers of depression that they are not alone in their feelings, and to illustrate to people who may not understand the illness the depths of what it can do to people.

Streaming video version of documentary about anxiety. Anxiety motivates us to get things done, but for some people, anxiety is not a driver. For many children, anxiety disrupts everyday life, interfering with their ability to make friends or go to school.
Through interviews with experts and three young people, this compelling documentary outlines the causes, symptoms and treatments for anxiety disorders and emphasizes the importance of early identification and intervention. In all of these stories there is hope.
2004, 56 min 31 s

Attending college or university opens up an exciting world of possibilities. It can also be pretty challenging. But if you’re living with a mental illness, you’ve faced challenges before. This resource is designed to make your transition to college or university just a little bit easier. It takes you through all the steps of going to school, providing information and tips for anyone living with a mental illness.

April Sullivan, M.A. Psychology, from the IWK Children's Hospital in Halifax, NS gives a talk on strategies for parents to help their child cope with anxiety and fears. Available for free streaming online.

Online service to help you find the help you need for depression, anxiety, and other mental health and substance use conditions. This includes:
* Local support groups and health services within Vancouver, Richmond, and Coastal communities
* Online information pages and workbooks provided through BC Partners for Mental Health and Addictions Information and other trusted BC sources
* Self-help or supported self-help programs such as the BC Canadian Mental Health Association’s Bounce Back® Online (available without a doctor’s referral)
* Valuable resources for friends and family members seeking information for their loved ones.

Vancouver Coastal Health/ Providence Health Care

Audience: Public (www.ementalhealth.ca)

Resource type: Mobile app, such as for iOS, Android, etc., Movies and videos, Printed materials including handouts, brochures and books, Websites including blogs, support forums

Started in 2000, MindMasters is a program that gives adults who work with or live with children, short, proven activities to do with children to help them learn positive living skills.
Adults teach children all sorts of skills - tying their shoes, reading a book, riding a bike, cooking a meal. These practical skills help children to learn to manage the workd. There are other skills that children need to learn too. How to relax in a dentist's chair. How to channel feeling of anger so no one gets hurt. How to focus on a task to get it done. How to keep upbeat when life seems hard. We all need these skills to excel at living, to make the most of opportunities life offers to us. The program was created by Dr. Terry Orlick with the assistance of graduate students at the University of Ottawa and feedback from children, social workers, nurses, teachers and counsellors who have been doing the activities with children and evaluating their success for years.
These positive-living skills activities have been assembled in the Mindmasters program and are being made available through the Positive Living Skills for Children project. You will find that the activities are suitable in all sorts of settings, particularly with children aged 4 to 12. You will find the music that supports the teaching of positive-living skills here.

The keys to taking care of youth mental health are to work towards building close and genuinely supportive relationships and promoting mental wellness, and to get help early should problems arise. This free guide was designed to help parents forge and strengthen those connections and support their youth's mental health.

OurHealthyMinds is about mental health. It celebrates the many ways we can be well, and honours the many ways we can experience mental illness - as an individual, a caregiver, a parent, a child or loved one.

School Letter

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About this letter: This is a sample “School Letter” that a health professional can write to a patient’s educators to support a student with anxiety. Feel free to cut/paste in your work.
Authors: This sample letter was written by Dr’s Olivia Macleod and the mental health professionals at the Children’s Hospital of Eastern Ontario (CHEO), in coll...

About this letter: This is a sample “School Letter” that a health professional can write to a patient’s educators to support a student with anxiety. Feel free to cut/paste in your work.

Authors: This sample letter was written by Dr’s Olivia Macleod and the mental health professionals at the Children’s Hospital of Eastern Ontario (CHEO), in collaboration with Donaleen Hawes and Michelle Neville, Catholic District School Board of Eastern Ontario (CDSBEO).

License: Under a Creative Commons License. You are free to share, copy and adapt this work in the work of helping your

students. Note however, that otherwise, this work may not be used for commercial purposes.

Dear Educator:

I am writing to give you an update regarding your student, who is coping with an Anxiety Condition.

I am writing to give you an update regarding your student, who is known to me for an anxiety condition. Anxiety is characterized by feeling that 1) the world and environment are unsafe, and/or 2) feeling unable to cope with the environment and manage uncertainty.

Accommodations are essential for this student to function in the academic program. Here is a list of general recommendations.

Ensure this student feels connected to the adults. Perhaps the single most important intervention that can help a student feel better able to cope with anxiety and safer is to help the student feel connected to caring adults at the school. This includes:

Finding time to connect at the beginning of the day

Accepting and validating the student’s anxiety, e.g. “I wonder if you’re feeling anxious… I appreciate it can’t be easy.”

Have breaks as needed in a designated “chill out space”. Use regular breaks as a preventive measure for stress buildup. Ensure that there are also opportunities for the student to let you know when things are stressful, and then the student can have a break as needed (i.e., break card). The “chill out space” is a space in a calmer (i.e. less sensory input), relatively private place at school where the student can use different coping strategies until the student is feeling calmer. Examples vary depending on the student and the school, but may include a corner in the classroom; or a resource room where there are less students; or the library.

Problem-solve and debrief anxiety incidents. After the student has calmed down, try to find a time to help problem-solve around triggers that led to the anxiety.

Set clear expectations and try to check if the student understands. Some students have anxiety because they want to please the teacher, yet they are uncertain about their teacher’s expectations, but are too anxious to let the teacher know that they don’t understand.

Chunk work. Be prepared to “chunk” larger work into smaller manageable pieces and provide ongoing feedback, or offers to help.

Expose the student to challenges step by step. For example, with performance anxiety, the student can initially present material only to the teacher or in small groups. If the student is successful with this, they can move towards presenting to larger and larger numbers of students, until it is the full class.

Don’t put him/her on the spot by calling on them to answer a question in front of the class. Even though the student may be perfectly capable of answering a question, the student may still be anxious with being the centre of attention.

Allow the student to choose a partner during group work and, when possible, allow him/her to work only with one partner (as opposed to a larger group).

Provide sensory materials (i.e., fidgets) to decrease feelings of stress thereby allowing the student to concentrate on the task at hand.

For tests and exams, consider a separate testing room and extra time if needed.

For older students, a reduced course load may be needed. The possibility of a resource period, or learning skills course, should be explored.

Strategies for Classroom Education and Destigmatizing Anxiety

Consider having a classroom lesson about anxiety, and ways of coping, which helps all students be more understanding with anxiety. Do not single out students with anxiety by mentioning their names, but rather make the lesson about anxiety in general.

Model self-compassion. For many students, anxiety is about feeling unsafe due to not measuring up to expectations around them. Teach self-compassion by ensuring that the classroom models the following:

Mindfulness: Teach students how to be in the moment, rather than distracted.

Kindness and compassion to others: Have a classroom that values kindness over competition.

Kindness and compassion to ourselves: When you hear students being self-critical, reframe the criticism in a positive and forgiving manner.

Gratitude: Consider incorporating gratitude into school routines, such as at the end of the classroom day.

Stop stigma and teasing. Deal immediately with any negative behavior by peers towards more sensitive students.

For more information about supporting students with anxiety in the school:

Building Resilient Students with Positive Mental Health
http://smh-assist.ca/blog/2016/03/15/building-resilient-students-with-positive-mental-health-flip-book-cdsbeo/

Thank you for the work you do every day in supporting this student. Please do not hesitate to contact me if you have any questions or comments.

NAME OF HEALTH PROFESSIONAL, TITLE

CONTACT INFORMATION

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I am writing to give you an update regarding your student, who having Mood Problems, i.e. Depression.
Accommodations are essential for this student to function in the academic program. Feel free to adapt this list, however, here is a general list of suggested accommodations.
Instructional Strategies
Interpersonal interventions
Fe...

I am writing to give you an update regarding your student, who having Mood Problems, i.e. Depression.

Accommodations are essential for this student to function in the academic program. Feel free to adapt this list, however, here is a general list of suggested accommodations.

Instructional Strategies

Interpersonal interventions

Feeling connected to people is particularly important with mood problems, particularly because students with mood problems youth tend to withdraw from others. Help connect the student to supportive peers, and offer opportunities to participate in organized school activities such as clubs, sports.

Make a special contact with the student each day. Maybe a specific greeting at the door followed by a question about something that has been of interest to the student.

Build strength and resiliency by reinforcing successes and positives

What times has your student been successful at things in the past? What are your student’s strengths? Tell the student about any positives.

Being successful and accomplishing tasks increases self-esteem so find ways to ensure the student has chances to achieve, even at his/her lower energy level and reduced ability to concentrate.

Reduce workload

Mood problems such as depression may lower the student’s ability to work. Consider temporarily reducing the academic expectations and workload. Just like one might modify job tasks for a worker with back injury, it is important to modify tasks for a student with mood problems.

Give more time

Students with mood problems tend to have problems with attention and concentration. Give more time, break assignments into smaller pieces, offer extra help in setting up schedules or study habits, or pair the student with others who express an interest in helping.

Coping / Stress Breaks (aka ‘Chill Time’) (Try to avoid the term ‘Time Out’ because for some students this has a negative connotation…)

Expressing stress -- Come up with a system to help the student identify when s/he is getting overwhelmed, and be able to communicate that to the teachers.

For example, using a 5-point scale, where 1 is no problems, and 5 is being stressed and overwhelmed

Create a safe space

Designate a “chill out zone” / “safe place” where the student can go if s/he is feeling overwhelmed. By giving the student the ability to calm down at school, this will lessen the chances that the student will end up leaving the school.

Talk ahead of time privately with the student, and set up some signal or cue so that the student can leave the class if the student is getting overwhelmed.

Set clear expectations

Many students have anxiety because they are uncertain about their teacher’s expectations. To help with this, provide the student with explicit guidelines for assignments. In addition, explicit guidelines for assignments help mitigate the negative impact of anxiety and depression symptoms on executive functioning. (Executive skills help a student to regulate his or her behavior. Through the use of these skills a student can plan and organize activities, sustain attention, and persist to complete a task.)

Classroom Education / Anti-Stigma

Consider having a lesson about mood problems, in order for other students to know about anxiety so that they can understand what the student with mood problems is going through. Do not single out the student with mood problems, but make the lesson a about mood problems in general. For more information, the CMHA has an excellent curriculum here www.cmha.ca/highschoolcurriculum/

Provide copies of classroom notes to cover absences due to anxiety, as the student may be missing classes due to anxiety, or doctor’s appointments.

Coping Plan

Involve the student in coming up with a coping plan, whose elements might include:

Student’s strengths

Potential problems or issues

Strategies and solutions to try

Suicidal ideation and crises

Although depression does get better in the vast majority of situations, youth with mood problems may become overwhelmed to the point where they may feel passively suicidal (“Life isn’t worth living”), or actively suicidal (“Life isn’t worth living, and I’m going to do something to end my life.”)

Learn about local resources (i.e. where you might get professional help) in case there are concerns about suicidality. Most likely, your school board already has a policy and procedure in place for such urgent situations.

Add to Info Cart

There are many ways that schools can help a child with panic disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifi...

There are many ways that schools can help a child with panic disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following:

Establish check-ins on arrival to see if the child can succeed in certain classes that day

Allow the student to “cue” teachers or staff if a panic attack is occurring so that the student can go to a less stressful (or embarrassing) environment. At the same time, reward the student for efforts to remain in class and control the panic attacks.

Provide more time to complete certain types of assignments

Accommodate late arrival due to symptoms at home

Adjust the homework load to prevent the child from becoming overwhelmed. Academic stressors, along with other stresses, may aggravate symptoms.

Develop relaxation techniques to help reduce anxiety at school. Employing techniques developed at home can also be useful.

Identify a safe place where the child may go to reduce anxiety during stressful periods. Developing guidelines for its appropriate use will help both the student and staff.

Encourage the child to develop helpful interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child's ability to problem-solve.

Anticipate issues such as school avoidance if there are unresolved social and/or academic problems

Provide assistance with peer interactions. An adult's help may be very beneficial for both the child and his or her peers.

Be aware that transitions may be difficult for the child. When a child with panic disorder refuses to follow directions, for example, the reason may be symptoms of anxiety rather than intentional oppositionality.

Flexibility and a supportive environment are essential for a student with panic disorder to achieve success in school. School faculty and parents together may be able to identify patterns of difficulty and develop remedies to reduce a child's challenges at these times.

Workplace Accommodation

Add to Info Cart

Examples of Common Workplace Accommodations
Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:
Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be f...

Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:

Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be from within the organization.

Flexible scheduling to accommodate effects of medications, time for appointments, more frequent breaks, switch to temporary part-time hours without fear of losing job.

Changes in supervision, for example how feedback and instruction are given, or having weekly supervision appointments to check in and prevent problems before they can happen.

In training, allowing more time for tasks to be learned, or allowing for individualized, one-on-one training.

Appropriate technology like a tape recorder to tape instructions, head phones to block out loud noise, etc.

Modifying work space or changing location so it is quieter, fewer distractions; allowing an employee to work at home.

Allowing an employee to exchange minor job tasks with others.

Rights and Responsibilities of the Employer & Employee

The Employer Should:

Create and maintain an atmosphere where people feel comfortable asking for accommodation, including providing information about the organization’s policies and creating ways for requests to happen confidentially.

Assume that the employee’s request for accommodation is made in good faith.

In a timely manner, work with the employee (and a professional, if necessary), to explore all options for accommodation.

Maintain records of the request and steps taken to deal with the request.

Maintain and respect confidentiality issues.

Pay the cost of the accommodations, including fees for any medical certificates required.

Request only information that is directly related to developing an appropriate accommodation.

Ensure that managers and supervisory staff will not tolerate any discrimination or harassment as a result of an illness or an accommodation.

The Employee Should

Tell the employer you need an accommodation, due to a disability, and give them the information they need to understand what the limitations are and what accommodations would address them.